Academic journal article Perspectives in Public Health

Professional Training to Reduce Children's Exposure to Secondhand Smoke in the Home: Evidence-Based Considerations on Targeting and Content

Academic journal article Perspectives in Public Health

Professional Training to Reduce Children's Exposure to Secondhand Smoke in the Home: Evidence-Based Considerations on Targeting and Content

Article excerpt


Aims: Proponents of theory-based evaluations argue that the type of evidence needed by public health decision-makers is not simply whether interventions work or not. A more fruitful approach is to understand the contexts and circumstances associated with effectiveness.

This article aims: to firstly understand factors influencing professionals' practice following their participation in training that aimed to reduce children's exposure to second-hand smoke (SHS) in the home via increased usage of brief interventions; and secondly to consider the implications of these factors for improving the skills of a diverse workforce.

Methods: Questionnaires were issued to the 231 participants pre- and post-training and at three-month follow-up. Four focus groups and four interviews were run with 16 people who had attended the training in the previous four to eight months and who performed a wide range of professional roles, reflecting the diversity of those trained.

Results: The three-month follow-up data indicated that some, but not all, participants had engaged in components of the brief intervention and changed their practice. This difference was largely explained by professional role. Those working in a health-visiting role or team were considered better placed to support families through a process of restricting SHS exposure in the home. Triangulated data also indicated that these professionals more often practised elements of the brief intervention. There was also some evidence that the training did not equip participants with the full range of information they wanted, or with the skills that they felt that they needed.

Conclusions: Decisions on who to target for training need to be informed by an understanding of the contexts in which professionals work and the opportunities and constraints within these. Those working in a health-visiting team are credible message carriers, have opportunities to develop a relationship with families, and can be well placed to provide families with sustained support. To do so, they need clear messages on precisely how to reduce exposure. In addition, they need the skills to support families through a process of change.


Second-hand smoke; children's exposure to second-hand smoke; training evaluation; changing professionals' practice; targeting training


Second-hand smoke (SHS), also known as 'environmental tobacco smoke' or 'passive smoking', comprises exhaled mainstream smoke and side-stream smoke from the lit end of a cigarette.1 Due to its noxious mix of toxins and human carcinogens, SHS has been classified as a significant public health hazard2 leading to legislation across the UK prohibiting smoking in most enclosed public spaces and workplaces (Smoking, Health and Social Care (Scotland) Act 2005, Health Act 2006 and Smoking (Northern Ireland) Order 2006). These acts place no legislative restrictions on whether people smoke in the privacy of their own homes.

Babies and children are particularly vulnerable to the effects of SHS: because of their smaller bodies, they breathe more quickly and inhale more pollutants per pound of body weight,3 placing them at increased risk of sudden infant death syndrome, asthma, lower respiratory infections, bronchitis, middle ear disease such as glue ear and bacterial meningitis.4,5

Parental tobacco smoking is the predominant source of SHS among children,6-8 making the domestic home the most significant environment for children's exposure to SHS,9 particularly for those under the age of five who spend so much of their time at home.10 As a consequence, there are concerns, including in the UK4 and the USA,5 regarding the substantial exposure that is experienced by babies and children in households with smokers.

Children's exposure to SHS is an inequalities issue too: as smoking is more prevalent in lower socio-economic groups11 and as children from poorer backgrounds are less likely to spend time in regulated child care,12 and therefore more time being cared for by their parents, relatives or neighbours,13 children from poorer backgrounds are at a heightened risk of exposure to SHS in the home. …

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